Imaging

Olecranon Bursitis

Preliminary Diagnosis: Olecranon Bursitis

I. What imaging technique is first-line for this diagnosis?

  • MRI with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of olecranon bursitis.

Advantages

  • Able to detect other causes of pain or weakness in the joint such as triceps tendinopathy, tenosynovitis, tears or ulnar nerve damage

  • Does not make use of ionizing radiation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on case-by-case basis with a GFR greater than 30 and less than 60.

III. What are the contraindications for the first-line imaging technique?

  • Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodes

IV. What alternative imaging techniques are available?

  • Plain film radiography

  • Ultrasound

  • CT with or without contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of olecranon bursitis.

Plain Film Radiography

Advantages

  • Inexpensive and easy to perform

  • Requires less patient cooperation than MRI

  • Can detect associated fracture if related to trauma or osseous erosions of osteomyelitis if infectious etiology suspected

  • Calcifications or gout easily seen

Disadvantages

  • Nonspecific

  • Unable to determine size or nature of swelling or fluid

Ultrasound

Advantages

  • Able to detect fluid collection and whether fluid is simple or complex

  • Can detect triceps tendinopathy, tendonitis, bursitis, tears or ulnar damage

  • Relatively inexpensive and portable imaging

  • Does not use ionizing radiation

Disadvantages

  • Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology

  • Limited evaluation in obese patients

CT with or without contrast

Advantages

  • Provides significant detail of bone abnormalities

  • Requires less patient cooperation and is associated with less motion artifact than MR imaging

Disadvantages

  • Exposes the patient to a large amount of ionizing radiation

  • Associated triceps tendon and ulnar nerve damage more difficult to detect than with MRI

  • Imaging with intravenous contrast requires that the patient have good renal function with a creatinine of 0.6-1.2mg/dL for an adult

VI. What are the contraindications for the alternative imaging techniques?

Plain Film Radiography

  • No significant contraindications exist. Some institutions may require consent for pregnant patients.

Ultrasound

  • No significant contraindications exist.

CT with or without contrast

  • Contraindicated in a pregnant patient, especially in the first two trimesters

  • Relative contraindication in allergy to contrast

  • Relative contraindication in patients with renal failure

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